By YASMEEN ABUTALEB
Capital News Service
COLLEGE PARK – She couldn’t see straight. She was nauseous. The stadium lights were giving her a blinding headache.
Lara White, then 13 and a freshman on the Walt Whitman High School girls’ varsity soccer team, didn’t know why her head hurt so much. She had been kicked in the head after falling to the ground while defending her team’s goal. She got back up, though; it didn’t seem like a big deal.
She had to ignore the pain. It would subside on its own, thought White, now 19 and a sophomore at the University of Maryland. There was a soccer game to play, and her team was relying on its defender to play until the final whistle blew.
The headache didn’t subside for days. Her coach at the Bethesda high school mandated she see a doctor, where she discovered her symptoms were consistent with a concussion.
“I really didn’t know anything about concussions,” White said. “I knew a concussion was your brain hitting your skull, but I didn’t understand how serious it was.”
Within a year, White said, she suffered a second concussion after falling to the ground in a soccer game. When she tried to stand up, she immediately fell down.
White is far from the only young female soccer player to underestimate the severity of concussions. A study published in March in JAMA Pediatrics found that concussion rates among female soccer players ages 11-14 are higher than those reported in older females. The majority of young girls go undiagnosed and continue to play with concussion symptoms, the authors wrote.
Athletes who continue to play with a concussion are at greater risk of incurring a second concussion and prolonged recovery. Without proper rest, athletes brains’ could swell, which could result in brain damage or fatal injuries.
Although concussion awareness has risen in professional, college and high school sports — especially as the NFL works to settle a lawsuit to compensate former players for traumatic head injuries — it has failed to reach youth sports to the same degree.
“Youth players traditionally lack injury tracking systems and are largely unstudied,” the authors wrote, “which is concerning since younger age and female sex are risk factors for sports-related concussion.”
Headers — when players jump up to propel the ball with their head — were responsible for about 30 percent of the concussions in the JAMA study: Often, heads collide with opponents’ heads, arms or elbows.
Researchers said information and statistics on concussions among younger athletes is sparse, and additional studies are needed to craft policies and guidelines to improve concussion education and awareness among young athletes. They also suggested parents and coaches ensure athletes undergo medical evaluations before each sports season.
Most middle schools do not perform baseline testing for concussion symptoms, and many parents, athletes and coaches are not well-educated in identifying the symptoms, so many young athletes do not seek medical care for what initially seems like a minor injury. High schools and colleges have more expansive staffs with assistant coaches and trainers who are typically educated in identifying myriad injuries.
At White’s high school, she and all her teammates received concussion baseline testing for balance, brain function and presence of existing concussion symptoms before the season started to ensure no one was playing with symptoms. If athletes appeared to have incurred a concussion, they were tested again to compare results.
Her middle school soccer team — at Pyle Middle School in Bethesda, Md. — did not take the same precaution.
Pyle still does not perform concussion baseline testing, said T.J. Caswell, the school’s athletic coordinator, because the school has not experienced many issues with concussions. All coaches and physical education teachers are required to take and pass a concussion course.
A Maryland concussion law passed in 2011 mandates any student suspected of having a concussion be removed from practice or play and barred from returning until he or she is cleared by a licensed medical professional. It also calls for the state education department to implement concussion awareness programs for coaches, school personnel, athletes and parents.
But the law is difficult to strictly enforce, and it’s hard to create a policy that covers everyone, said Kerry Lowrey, the deputy director of the Eastern region for the Network for Public Health Law, an organization that provides legal technical assistance to those promoting public health.
Both of White’s concussions were diagnosed in high school, but she suspects she played with at least one concussion in middle school. As a defender, she said she often fell hard to the ground, headed the ball or collided with other players.
“In middle school, I had no idea what the symptoms of a concussion were,” White said. “That has a lot to do with it; the girls in middle school really don’t know what a concussion is. I can remember times when I was on the ground.”
Ed Miller coaches his 14-year-old daughter’s rec team in Prince George’s County. He had to take an online test to receive certification for coaching, yet the test did not include concussion identification. The online classes did recommend minimizing heading in practice, he said.
He said he tries to take the necessary precautions to keep his players safe. One night in practice, a player got hit in the head with the ball, so Miller immediately notified her parents to follow up with a physician to ensure she didn’t have a concussion.
Birgit Meade, whose 14-year-old daughter plays for Miller’s team, said she doesn’t worry much about her daughter’s safety while playing soccer. “It’s like any other sport you do. There’s always a chance that two people collide, they’re both going for the ball,” Meade said. “It’s not the most likely thing, but can happen.”
When White received her first concussion diagnosis at 13 years old, she had to sit out of practice and games for a month. A second concussion in close time proximity could have led to bleeding in the brain, her doctor told her.
White wanted to play, but followed her doctor’s orders.
Yet many parents and athletes “doctor shop” to avoid the missed playing time, Lowrey said. They look for doctors who will clear them to play and expedite their recovery process.
Education remains the “No. 1 hurdle,” she said, as many parents and coaches don’t know how to identify concussion symptoms.
When White incurred her first concussion, she knew so little about concussions, she said, that she never suspected she might have one that could have had severe consequences.
“It’s not something you know, like when you break your arm,” White said. “There can be mild concussions, and you have no idea.”
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